Provider First Line Business Practice Location Address:
372 KINGSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-4332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-221-3999
Provider Business Practice Location Address Fax Number:
718-221-2482
Provider Enumeration Date:
09/01/2011